MEDICAL ACTION APPROVAL [INFORMED CONSENT]

I.

Definition Etymologically Informed Consent derived from the word informed that meaning is given or

information described or have elaborated and said consent , which means approval or permission. So I nformed Consent or Approval of Medical Action is approval of the patient or her family against medical action to be performed on him or his family after receiving an adequate explanation from the doctor. Approval of Medical Measures set out in the Ministry of Health Decree No. 585 of 1989. Medical approval action actually leads to the communication process psien doctor, not merely filling and signing the form. Therefore, a physician should be good at providing information about the disease or medical action to be performed on patients with easily understood language. Basically Approval of Medical Measures derived from the rights of patients in the patient physician relationship: 1. rights to self-determination 2. rights to obtain information From the point of view of the doctor's Approval of Medical Measures relating to the obligation to provide information to the physician and the patient's obligation to act in accordance with the medical standards of the medical profession. The function of informed consent According to Katz & Capran, the function of informed consent: promotion of individual autonomy. Protection of patients and subjects. Avoid cheating, fraud and coercion. Encourage careful research. Promotion of rational decision Include public.

Adequate information Adequate physician information is information that includes: 1. Diagnosis 2. measures proposed or planned 3. alternative procedure if there 4. interests and benefits of the medical action 5. Procedure execution or the workings of the medical doctors in action 6. risk that occurs when no action is 7. risks or side effects are contained in the act 8. Confirmation patient understanding of the information submitted so that they can make decisions 9. Voluntary patients in giving permission. 10. Prognosis Such information should be given by the doctor to the patient or family with a language that is easily understood. Doctors also confirm or pudding ensure that the patient or his family really have a grasp of the information submitted. Information should be given by the doctor who will perform the action directly.

II.

Medical Action Type Approval ( Informed Consent ) Approval of Medical Measures ( Informed Consent ) can be classified into two, namely: 1. Implied Consent , which consent is deemed to have been given, although no official statement, which under normal circumstances and in an emergency or emergency . On

emergency life-threatening, life-saving measures ( life saving ) does not require the approval of Medical Measures. 2. Expresed Consent, the Consent of Medical Measures given explicitly, either orally ( oral ) and written ( written ).

Types of Action Requiring Approval Medical action that requires the consent in writing is: 1. measures that are invasive and require operative or anesthesia, both for diagnosis and therapeutic measures are. 2. Measures special treatment, such as therapy or radiotherapy for cancer sitostatika 3. Specific actions related to the field of medical research or clinical trials (related to bioethics), are not addressed in this medical skill activities.

Eligible Gives Approval Guided by the Minister of Health No. 585 of 1989 concerning Medical Measures Agreement, then the right to give consent or agreement is signed patient who is an adult (over 21 years old or married) and in a healthy mental state. Medical measures wherever possible agreement signed by the patient. But in practice in the field of Medical Measures Agreement signed by more often the patient's family. This relates to patient readiness to undergo medical action or to sign the Medical Consent action. For patients under the age of 21 years and patients with mental disorders who signed the Agreement of Medical Action is a parent or guardian or next of kin. For patients who are not conscious, unconscious or not accompanied by immediate family and in a state of medical emergency and immediate action is necessary to save lives or that are not required approvals.

Witness To maintain the security and validity of Medical Measures Agreement required the witnesses from the family and from the hospital. Regarding the numbers no specific guidelines, but usually

there are 2 people, which represents one patient and one representing the hospital. But this is not absolute, it can be both from the family or from the hospital.

Forced action or refusal Round or Round On Demand Self Patients who refused to do medical action planned or already carried out by doctors despite getting adequate explanation must provide a written statement. Usually at the front of the medical record available formats rejection or action or forced return home at his own request (APS). This written statement is important to avoid lawsuits against the doctor if any bad consequences in patients who refuse medical acts performed on him. Implementation Guidelines for Medical Skills Training 1. Simulate portray relationships between students and patients requiring doctors Medical Measures Agreement. 2. Practice provide adequate information in accordance with the criteria of adequate information which has been given above. 3. Practice provides information on a wide range of medical action that you already know. 4. Make or fill format of Medical Measures Agreement in accordance with a trained case. 5. Notice checklist as a guide in the implementation of the exercise Medical Measures Approval Checklist ( Informed Consent ) No. Item 0 1 2 3 Fostering a sense of connection Introducing himself as a medical doctor in charge of the action to be performed Confirm the identity of the patient or his family and relationships with patients kekeluargaannya Value 1 2

4 5

Explain the patient's disease diagnosis Explains the types of actions to be performed on the patient and their benefits for patients

6 7 8

Explaining the procedure or procedures of the medical action Explain the consequences if these measures are not carried out Explain the risks and side effects of medical action and how to anticipate or overcome

9 10 11

Explain the action when alternatives exist and the pros and cons Explain the prognosis of patients with or without medical action Confirm the patient's or family's level of understanding of the information provided

12

Gives the opportunity (time) to patients or their families to consider approval of the decision to act

13

Asking willingness or consent of patients or their families against the medical action and achieving agreement or consent voluntarily and without coercion

14

Filling format and Medical Measures Agreement signed with the patient or his family and witnesses. Points Total

Assessment Criteria Checklist Medical Measures Agreement ( Informed Consent ) No. Item Value

Fostering a sense of connection a. Saying greeting b. Talking to behave friendly and polite and show a reasonable eye contact c. Able Islami Only items 1-2 above Do not do the above items or look un-Islamic

1 0 2

Introducing himself as a medical doctor in charge of the action to be performed a. Introducing behalf doctor b. Inform yourself as the executor of the planned medical action Only 1 item Not introduce myself

1 0 2

Confirm the identity of the patient or his family and relationships with patients kekeluargaannya a. Asking name, age, address and familial relationship with the patient and when no identity card number / ID card b. Confirming the name, age and address of the patient as well as a treatment Only 1 item or incomplete in ask for your name, address, age Did not confirm the identity of the family or the patient

1 0 1

Explain the patient's disease diagnosis Explain the diagnosis of patients with empathy Not explain or clarify the diagnosis but not with empathy

Explains the types of actions to be performed on the patient and their benefits for patients a. Explaining the name of medical action b. Explaining the benefits of medical action for patient correctly c. Explain with an easily understood Only 1-2 items Not perform or wrong in explaining or too much use of medical terminology elusive

1 0 1

Explaining the procedure or procedures of the medical action Correctly Not explain or explain but one

0 2

Explain the consequences if these measures are not carried out a. Gives correct explanation of the consequences when medical action is not done b. Unimpressed scare Only one item on the Not explain

1 0 2

Explain the risks and side effects of medical action is properly a. Describe the risk for actions b. Explain side effects after action c. Describe anticipated or doctor measures to minimize or address the risks and side effects of the action Only items 1-2 above

Not explain 9 Explain the action when alternatives exist and the pros and cons a. Describe other alternatives of action b. Explain the advantages and disadvantages of alternative actions Only 1 item Not doing 10 Explain the prognosis of patients with or without medical action correctly Not explain the prognosis of patients 11 Confirm the patient's or family's level of understanding of the information provided Did not confirm the patient or family understanding of the information provided 12 Gives the opportunity (time) to patients or their families to consider the actions of the consent decree (the length of the simulation only) No time for thought or consideration or consultation with other family members 13 Asking willingness or consent of patients or their families against the medical action and achieving agreement or consent voluntarily and without coercion a. Asking the patient or her family against the decision of medical action planned b. Asking a voluntary patient (do not feel forced) Only 1 point Not doing 14 Filling format and Medical Measures Agreement signed with the patient or his

0 2

1 0 1 0 1 0 1

0 2

1 0 2

family and witnesses. Writing stuffing Medical Measures Agreement format correctly and completely Write or fill in but not complete Not filling Maximum Total Points 1 0 23

Score = Total Score x 100